My neighbor's husband is an alcoholic and she is now noticing that he can no longer care for himself, such as go to the bathroom by himself or walk or bathe himself. He recently fell after trying to go to the bathroom by himself and had crapped everywhere. His wife has health problems of her own and not enough strength to lift his dead weight so after some time of him being on the floor he was able to use his walker to get up off the floor and he told his wife to call an ambulance, which she did, but the hospital is saying that he is alright to go home. And he is telling his wife that she made him go to the hospital and that if she doesn't come get him he will call a cab. I am pretty sure that is the alcohol talking since he couldn't have any while he was in the hospital. She will not be able to care for him when he does come home and is in tears not knowing what to do to get him the help she needs. Please let me know what steps she can take to get him into an Adult care facility.

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Shane made some good points.

It sounds like to me there may be some Dementia here. If he has a problem because of a med he is taking, time for Depends. If he is competent other than being an alcoholic than he can clean up his own mess. Everytime he falls and can't get up, call 911. Get it on record. She may eventually be told they can't continue to come. Get that in writing.

If he is ever in rehab, have her have him evaluated for Long term care. If he fits the criteria and rehab is one and the same he will transfer much easier. If assets are low, she can apply for Medicaid and become the Community Spouse. She will not be made impoverished. She will still be able to live in the home and have a car.

It maybe in her best interest now in finding out how she can protect herself. You need a lawyer versed in Medicaid. Too many couples think they have to spend down all their savings and investments before Medicaid will take over. There are ways for her to protect herself. There are probably limits depending on ur finances but assets, other than monthly income, can be split with the person needing care spending down his/her portion. With my GFs parents situation, they had 60k in savings. Father needed LTC. Medicaid allowed a 50/50 split with Dad having to spend down his half then Medicaid took over.
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Is the issue he is physically unable to take care of himself because of illness or because of alcohol? The gist I'm getting is it's more due to alcohol consumption than any underlying health related issue. If that's the case, this might be something to discuss with AA or Al-Anon. They might have some better ideas for resources. I'll bet with this pandemic, there are online chat rooms with both groups where you might be able to get some ideas.
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If he is competent he has the right to make his decision on where he lives. Is he?

Only option for your neighbor may be for her to leave.
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Let me preface this answer with the fact that this Coronavirus has temporarily turned the Health Care system upside down. There is no “normal” these days and my answer is written with this in mind.

Have your neighbor step up and inform the DC planner of her concerns. If they didn’t keep him 3 nights (the mandatory trigger for Medicare admission) or under observation it will be difficult to get the ER doctor to write rehab orders. If he’s an alcoholic a SNF/Rehab center won’t be able to deal with his withdraws symptoms from alcohol, thus a residential addiction center may be ordered first.

Medicare won’t pay for rehab without an order, whether for alcohol treatment or due to ADL deficits. With Covid 19 many nursing homes are full. Many rehab centers, even in the hospital, are also closed or working with decreased staff. This person’s alcoholism is not a priority right now. If the hospital staff feel he is a threat to anyone or himself they will send him to a psych hospital and not recommend he go home.

Realize too that once he comes home he will be in isolation / self quarantine for 14 days. That is one DC order given now to anyone that was treated in a hospital setting due to potential exposure to the virus.

Have your neighbor ask the ER MD about the availability of residential rehab for alcoholism treatment- but I know for a fact none of them are accepting new patients now. The hospital won’t keep him forever and he may be sober and able to perform for the hospital staff enough to fool them to persuade them that he is ok.

Your neighbor can’t expect the HC system in the middle of a pandemic to take care of her husbands no doubt long history of alcoholism. Has he sought treatment prior to this fall? Does he have a PCP? The PCP can begin the process of finding him a Recovery Rehab center to treat his addiction.

Don’t be surprised if he arrives back home via taxi. Right now the HC system is tapped out. Many behavioral health therapists are working with suicidal patients who need support due to Covid19 , those depressed over losing their loved ones to this virus, as well as folks losing their jobs b/o Covid and don’t know how they will feed their families. Patients are triaged to assess their immediate needs & your neighbors may be low on the totem pole if he has sobered up and able to have a discussion with the triage nurse and tells her he wants to go home. If he presents well to the DC planner he is going home.

My point is that if this is the first time the husband was evaluated in the ER due to diarrhea from drinking most likely he will be sent home with instructions to see his PCP for follow up. . He could have diarrhea from a med called Lactulose which is given to help chronic alcoholics to excrete ammonia associated with liver disease from long term drinking. We just don’t know.

Most importantly is the husband of sound mind and deemed to be able to make decisions about his care independently? If not your neighbor needs to get guardianship over her husband and prove he is mentally incompetent to make him get treatment.

If the husband doesn’t think he has a problem this is all for naught. He has to realize he needs help otherwise it’s moot.
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Wife should ask for the hospital social worker to develop a discharge plan, where all his issues are taken into consideration. She can tell the social worker that the hospital is planning an "unsafe discharge" with things the way they are. The social workers can go over her options for his discharge. It sounds like he may be in need of a nursing home at this point or at the very least, a rehab hospital for people who are not ready to be on their own. If the spouse is falling, the hospital can expect to see him again and again. And 50% of elderly who start to fall will be dead within 2 years. That's an actuarial fact. And it's why hospitals, physicians and elder care facilities are so concerned about falls.
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